ALEXANDRIA, VA --The American Academy of Otolaryngology-Head and Neck Surgery Foundation published the Clinical Practice Guideline: Sudden Hearing Loss (Update) today in Otolaryngology-Head and Neck Surgery. Sudden sensorineural hearing loss (SSNHL) affects five to 27 per 100,000 people annually, with about 66,000 new cases per year in the United States.
"Sudden hearing loss is a frightening symptom for patients that can dramatically decrease their quality of life. Prompt recognition and management of sudden sensorineural hearing loss may improve hearing recovery and quality of life. That is the overarching objective and purpose of this guideline update," said Seth R. Schwartz, MD, MPH, who served as the methodologist for both the 2012 guideline and the 2019 guideline update.
SHL is defined as a rapid-onset subjective sensation of hearing impairment in one or both ears. The hearing loss in SHL may be a conductive hearing loss (CHL), sensorineural hearing loss (SNHL), or mixed hearing loss, defined as both CHL and SNHL occurring in the same ear. CHL and the conductive component of mixed hearing loss may be due to an abnormality in the ear canal, tympanic membrane (''ear drum''), or middle ear.
For most patients with SHL, their medical journey often starts at an emergency room, urgent care clinic or primary care physician's office, with dizziness present in 30 to 60 percent of cases. The initial recommendations of this guideline update address distinguishing SSNHL from CHL at the initial presentation with hearing loss. They also clarify the need to identify rare, nonidiopathic SSNHL to help separate those patients from those with idiopathic sensorineural hearing loss (ISSNHL), who are the target population for the therapeutic interventions that make up the bulk of the guideline update. By focusing on opportunities for quality improvement, this guideline should improve diagnostic accuracy, facilitate prompt intervention, decrease variations in management, reduce unnecessary tests and imaging procedures, and improve hearing and rehabilitative outcomes for impacted patients.
"While the original guideline was a big step, this update provides an opportunity to improve diagnostic accuracy, facilitate prompt intervention, reduce unnecessary tests, and improve hearing and rehabilitative outcomes for patients," said Dr. Schwartz. "Sudden sensorineural hearing loss, particularly when accompanied by tinnitus and dizziness, can cause a great reduction of quality of life. Patients may experience fear and frustration at the inability to identify a cause for their hearing loss. The impact of this condition on a patient's function and well-being underlies the importance of an updated guideline to optimize care of patients with this debilitating condition."
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The update highlights urgency in managing this condition, by emphasizing early hearing testing to confirm the diagnosis and early initiation of therapy. Changes from the prior guideline also include the incorporation of new evidence profiles to include quality improvement opportunities, confidence in the evidence, and differences of opinion; inclusion of 10 clinical practice guidelines, 29 new systematic reviews, and 36 new randomized controlled trials; addition of an algorithm outlining how the Key Action Statements (KASs) integrate into patient care; enhanced emphasis on patient education and shared decision-making with tools provided to assist, among a number of other differences noted specifically in the guideline.
Of the 14 KASs, the guideline update group made strong recommendations against the following: 1) Clinicians should not order routine computed tomography (CT) of the head in the initial evaluation of a patient with presumptive SSNHL; 2) Clinicians should not obtain routine laboratory tests in patients with SSNHL; and 3) Clinicians should not routinely prescribe antivirals, thrombolytics, vasodilators, or vasoactive substances to patients with SSNHL.
This multidisciplinary guideline update is intended for all clinicals who diagnose or manage adult patients, 18 years of age or older, who present with SHL.
Members of the media who wish to obtain a copy of the guideline or request an interview should contact: Tina Maggio at 703-535-3762, or newsroom@entnet.org. Upon release, the guideline and other supplemental materials can be found at http://www.entnet.org/SHLCPG.
About the AAO-HNS/F
The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) represents approximately 12,000 specialists worldwide who treat the ear, nose, throat, and related structures of the head and neck. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and lifelong learning.